Clinical Case 3

Derrick a 77-year-old gentleman presents to the ED by ambulance from his nursing home. Recently he has been quite well, but over the last two days has become increasing agitated, particularly at night. He is now refusing food, he is unsure of where he is and wants to go home. He also states that staff have been stealing from him. He has a history of Alzheimer’s disease, hypertension and ischaemic heart disease. He has no past psychiatric history.

His mental state examination is as follows:

Appearance and behaviour: He is well dressed but agitated

Speech: Normal

Effect: Irritable mood, and an anxious affect

Perception: No hallucinations

Thoughts: His accusations about staff stealing things maybe delusional or misinterpretations

Insight: He has limited insight

Cognition: He is not orientated to time or place and is confused.